Case Study: Dag Barstow
Scenario:
Dag is a 2-year-old boy whose father brings him to the pediatrician’s office with a chief complaint of a purple rash on his legs. The nurse notes that Dag has symmetrical purple patches on his buttocks and lower extremities. There is no associated urticaria (raised wheals that may itch) or erythema (redness). The nurse notes that Dag has nonpitting edema (swelling) of his scalp, eyelids, lips, ears, and scrotum, and the dorsal surfaces of his hands and feet.
His vital signs are as follows: blood pressure is 98/59 mm Hg, oral temperature is 99.0°F (37.2°C), heart rate is 88 beats per minute, and respiratory rate is 25 breaths per minute. Dag’s weight today is 28 pounds (12.7 kg).
Further assessment shows that no joint pain or swelling is noted. Dag’s knees, ankles, hips, wrists, elbows, and shoulders have full range of motion. His lung sounds are clear bilaterally, and his heartbeat is regular and without murmur. His oral mucous membranes are slightly sticky or dry. No erythema, petechiae, or purpura is noted in the oral cavity. His nares are patent, and his pupils are equal and reactive to light.
Dag’s tympanic membranes are pearly gray with good landmarks. His neck is supple and without lymphadenopathy. His skin turgor is rapid (< 2 seconds). Dag’s urine color is dark yellow. He is complaining of cramping abdominal pain without vomiting. His father says that he has some nausea and his appetite is decreased. Dag only ate half of his breakfast today. The father also noticed that his last bowel movement had some mucus. Dag’s stool is positive for occult blood. His urinalysis is positive for blood, casts, and protein.
Dag is diagnosed with Henoch-Schönlein purpura with edema and gastrointestinal involvement. Because Dag has renal involvement, he is admitted to the hospital for medical treatment.
Critical Thinking Questions
- What complications might Dag encounter secondary to his diagnosis of Henoch-Schönlein purpura?
- What are the priority nursing diagnoses at this time?
- What are the expected nursing outcomes related to this scenario?
